| NPI | 1083279988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 300127) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101271373) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2023-08-11 |