| NPI | 1205863909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A62970) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G85917) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-02-25 |