| NPI | 1982634432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9562) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A9562) |
| 207P00000X Emergency Medicine (Licence: TX S4650) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-02-12 |