| NPI | 1871835389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A156222) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2018-0856) |
| 207P00000X Emergency Medicine (Licence: WI 74827-20) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2022-11-18 |