| NPI | 1457318164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA c53462) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD417831) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-11-21 |