| NPI | 1699718056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 39475) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 39475) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-05-24 |