| NPI | 1891832051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A74386) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A74386) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-07-07 |