| NPI | 1174566574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E1887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-1887) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-09-26 |