| NPI | 1407828585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52509) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 113851) |
| 208000000X Pediatrics (Licence: CA c52509) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2013-06-10 |