| NPI | 1972557502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A10519) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WA OP00001813) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-03-04 |