| NPI | 1902074503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ au-2903599-9914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 42437) |
| 208D00000X General Practice (Licence: CT 050155) | |
| 207P00000X Emergency Medicine (Licence: KY 42437) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2015-07-08 |