| NPI | 1295969251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 169782-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 169782-1205) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2010-08-17 |