| NPI | 1871088203 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101026344) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101024309) |
| 208D00000X General Practice (Licence: MI 5151011197) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-11-16 |