| NPI | 1982091732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 57454) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A148476) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2026-09-14 |