| NPI | 1669564092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7668) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP61674079) |
| 207P00000X Emergency Medicine (Licence: OR DO225517) | |
| 207Q00000X Family Medicine (Licence: CO DR.0076079) | |
| 207P00000X Emergency Medicine (Licence: CA 8427) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2026-03-16 |