| NPI | 1043263890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101238926) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101238926) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-02-15 |