| NPI | 1770999468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA C177581) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101268765) |
| 207P00000X Emergency Medicine (Licence: FL ME131478) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-11-10 |