| NPI | 1215957451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A34017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A34017) |
| 208600000X Surgery (Licence: CA A34017) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2010-06-11 |