| NPI | 1881076644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 12935) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016029998) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-06-11 |