| NPI | 1538384953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 21437) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 21437) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-03-07 |