| NPI | 1124062039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A78159) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A78159) |
| 207R00000X Internal Medicine (Licence: CA A78159) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-04-19 |