| NPI | 1366400111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 19686) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 046511) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2019-07-19 |