| NPI | 1912927229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 5646) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 5646) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-02-24 |