| NPI | 1285865154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR E-7968) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A142540) |
| 207Q00000X Family Medicine (Licence: MI 4301095067) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2018-11-02 |