| NPI | 1043626278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PR 21218) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13538-I) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2019-11-19 |