| NPI | 1063446763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A92757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 15347R) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2015-01-19 |