| NPI | 1740939172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A202552) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.149750) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-06-13 |