| NPI | 1306801766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A64738) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A64738) |
| 207P00000X Emergency Medicine (Licence: IN 01051619) | |
| 207P00000X Emergency Medicine (Licence: MI 4301082809) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-10-07 |