| NPI | 1316147416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 19081) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 19081) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-09-05 |