| NPI | 1578615001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 14846) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS MS14846) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-12-07 |