| NPI | 1407422199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22556) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 22556) |
| 261QE0002X Clinic/Center, Emergency Care (Licence: PR 22556) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-10-14 |