| NPI | 1861472029 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208D00000X General Practice (Licence: TX L4791) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L4791) | 
| Enumeration Date | 2006-01-21 | 
| Last Update Date | 2025-09-30 |