| NPI | 1851394217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS8124) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| 208D00000X General Practice (Licence: FL OS8124) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2025-09-25 |