| NPI | 1821334608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 179561) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 20246) |
| Enumeration Date | 2012-12-22 |
| Last Update Date | 2026-03-02 |