| NPI | 1659509743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A129904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A129904) |
| 207Q00000X Family Medicine (Licence: MI 4301094451) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2022-01-11 |