| NPI | 1417212739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A78625) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A78625) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |