| NPI | 1336164771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: CA G51667) |
| Additional Taxonomies | 207RC0200X Internal Medicine Critical Care Medicine (Licence: CA G51667) |
| 208600000X Surgery (Licence: CA G51667) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-09 |