| NPI | 1912007881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 21738) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101240471) |
| 208D00000X General Practice (Licence: HI 14799) | |
| 207P00000X Emergency Medicine (Licence: MS 21738) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-02-08 |