| NPI | 1912917162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G37396) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G37396) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-05-01 |