| NPI | 1639135239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 33418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0023981) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2019-12-09 |