| NPI | 1265455141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 02343) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 02343) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-05-05 |