| NPI | 1619130739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A114441) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A114441) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2016-04-04 |