| NPI | 1154650943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 27725R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 27725R) |
| 207P00000X Emergency Medicine (Licence: FL ME111068) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2017-01-23 |