| NPI | 1851786925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 79770) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 79770) |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2025-09-08 |