| NPI | 1619362373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA PGY.202831) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 303798) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2016-09-12 |