| NPI | 1033538335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101259615) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX BP10050230) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-07-14 |