| NPI | 1518422302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 73940-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 73940-20) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2022-12-09 |