| NPI | 1578501011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 112558) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA G87569) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2014-12-09 |