| NPI | 1548876121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24685) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 24685) |
| Enumeration Date | 2020-09-19 |
| Last Update Date | 2026-05-24 |