| NPI | 1902227788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A13283) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 172983) |
| Enumeration Date | 2013-12-23 |
| Last Update Date | 2022-02-11 |