| NPI | 1043234602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD.016647) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 016657) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-05-20 |