| NPI | 1164544045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E-5307) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-5307) |
| 208D00000X General Practice (Licence: AR E5307) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-04-02 |