| NPI | 1003828633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G138326) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 28795) |
| 208D00000X General Practice (Licence: KY 28795) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2023-04-28 |