| NPI | 1255513768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J9242) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J9242) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2014-01-30 |