| NPI | 1528009594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4200) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA 20A4200) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA 20A4200) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-02-29 |