| NPI | 1154383875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G057950) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G57950) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2012-07-18 |