| NPI | 1871673053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101240262) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101240262) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2014-08-29 |