| NPI | 1952455693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 038689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 038689) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-03-14 |