| NPI | 1215077102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54770) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200300979) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2017-03-23 |