| NPI | 1922007889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 20386) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 20386) |
| 207P00000X Emergency Medicine (Licence: MO 119907) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-10-29 |