| NPI | 1265410351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101015106) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 5101015106) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2024-07-16 |