| NPI | 1811161045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ACN-502) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN 502) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2014-10-21 |