| NPI | 1003015462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A106131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A106131) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD 22015) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2022-09-06 |