| NPI | 1871585265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 15554) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: PR 15554) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: PR 15554) | |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: PR 15554) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2015-05-05 |