| NPI | 1174082556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A24549) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A24549) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-11-26 |