| NPI | 1871782953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A100572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2007-0396) |
| 207P00000X Emergency Medicine (Licence: CA A100572) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2026-03-16 |