| NPI | 1104598267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22549) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 22549) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-01-25 |