| NPI | 1023167897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A101036) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: WA MD 60484309) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2014-08-11 |