| NPI | 1194318063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81318-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 81318-20) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2024-10-01 |