| NPI | 1598812596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A33886) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA A33886) |
| 207Q00000X Family Medicine (Licence: CA A33886) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-11-08 |