| NPI | 1689657868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 5017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 5017) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2009-12-28 |