| NPI | 1194762625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 042042) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 42042) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-05-07 |