| NPI | 1003807306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101007225) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A4278) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2018-06-21 |