| NPI | 1316977812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 35020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 35020) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-08-10 |