| NPI | 1679890321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 205042) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 205042) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2015-10-28 |