| NPI | 1548453814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A96855) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A96855) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2025-06-18 |