| NPI | 1891763991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101011419) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101011419) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |