| NPI | 1790038974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A122967) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 55760) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2016-01-20 |