| NPI | 1457391161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD.025271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 025271) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: LA 025271) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2020-12-30 |