| NPI | 1205164050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V7105) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA a123563) |
| 208D00000X General Practice (Licence: CA A123563) | |
| 208D00000X General Practice (Licence: AZ 46698) | |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2025-04-11 |