| NPI | 1669428371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 81748) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS8141) |
| 208D00000X General Practice (Licence: FL OS8141) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2025-01-30 |