| NPI | 1902816390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G69203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G69203) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-06-19 |