| NPI | 1548605694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 28326) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU MTL-2019-017) |
| 207P00000X Emergency Medicine (Licence: GU M-2178) | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2019-09-25 |