| NPI | 1780187302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C-8150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR C-8150) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-06-16 |