| NPI | 1285260109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 46451) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 04-45677) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-12-04 |