| NPI | 1629309000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 07253R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 07253R) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2016-09-23 |