| NPI | 1578540340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 26300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 145278) |
| 207Q00000X Family Medicine (Licence: GA 26300) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2025-01-07 |