| NPI | 1265819163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A146206) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A146206) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2022-06-30 |