| NPI | 1912344649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A15222) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015478) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-12-03 |