| NPI | 1538661517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14563-I) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V4319) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2025-11-09 |