| NPI | 1790758530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD70024144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA C529720) |
| 207R00000X Internal Medicine (Licence: CA C52972) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2026-01-08 |