| NPI | 1093887184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IA 22221) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 22221) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2019-03-20 |