| NPI | 1730473737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 983) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 006579) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2017-03-15 |