| NPI | 1861479362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G55088) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA G55088) |
| 208D00000X General Practice (Licence: CA G55088) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2017-11-01 |