| NPI | 1003902164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53606) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 8735) |
| 207P00000X Emergency Medicine (Licence: CA C53606) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-05-06 |