| NPI | 1750365045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C33961) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA C33961) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: CA C33961) | |
| 207P00000X Emergency Medicine (Licence: CA C33961) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-12-01 |