| NPI | 1134358641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A128255) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC 0) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2019-01-23 |