| NPI | 1851064307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15625i) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 22447) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2021-07-30 |