| NPI | 1669707063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G32125) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G32125) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2010-04-14 |