| NPI | 1285862615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A122316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122316) |
| 207Q00000X Family Medicine (Licence: MS 21758) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-12-22 |