| NPI | 1578561304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301049187) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI MW049187) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2024-11-12 |