| NPI | 1902080500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A115777) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0068898) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2022-02-11 |