| NPI | 1457700015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A19691) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO 5010) |
| Enumeration Date | 2016-06-05 |
| Last Update Date | 2022-07-14 |