| NPI | 1790049898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA a146385) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2014011275) |
| 207P00000X Emergency Medicine (Licence: NY 309038) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-07-15 |