| NPI | 1952342586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 11045) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 19758) |
| 207P00000X Emergency Medicine (Licence: MS 11045) | |
| 208D00000X General Practice (Licence: TN 019758) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-07-24 |