| NPI | 1790756815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 23355) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60130455) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2010-08-04 |