| NPI | 1972544369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 45341) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 41398-020) |
| 207P00000X Emergency Medicine (Licence: CA A87958) | |
| 207P00000X Emergency Medicine (Licence: MN 45341) | |
| 207Q00000X Family Medicine (Licence: WI 41398-020) | |
| 207Q00000X Family Medicine (Licence: CA A87958) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-03-25 |