| NPI | 1083865810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A104254) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A104254) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2024-03-08 |