| NPI | 1730526005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101026342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101026342) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2025-12-04 |