| NPI | 1972511186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G74961) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G74961) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2018-11-21 |