| NPI | 1477844041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2016015085) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 48869) |
| 208D00000X General Practice (Licence: CA A122189) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2019-11-21 |