| NPI | 1144975400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 22606) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2024-08-05 |