| NPI | 1104146307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 051591) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 051591) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2024-11-12 |