| NPI | 1902919665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A45383) |
| 207Q00000X Family Medicine (Licence: CA A45383) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2018-09-25 |