| NPI | 1912220435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A5016) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA 20A5016) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2010-03-11 |