| NPI | 1366821357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2019032244) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101261725) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2019-09-05 |