| NPI | 1124066741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15042) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 15042) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2011-11-18 |