| NPI | 1790984730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 44363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A100750) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2010-09-30 |