| NPI | 1164662714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA G036719) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G036719) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2014-03-19 |