| NPI | 1396940854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A109689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A109689) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-03-27 |