| NPI | 1811076995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 201157) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.201157) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-01-21 |