| NPI | 1902854250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102201001) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102201001) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-08-07 |