| NPI | 1326595752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19216) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PR 19216) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-10-25 |