| NPI | 1104890284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 030945) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 030945) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-11-05 |