| NPI | 1750523478 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A112396) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD151030) | 
| 207P00000X Emergency Medicine (Licence: IL 125052602) | |
| Enumeration Date | 2009-03-26 | 
| Last Update Date | 2021-12-09 |