| NPI | 1952563371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 89722) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 89722) |
| 208D00000X General Practice (Licence: SC 1560) | |
| 207P00000X Emergency Medicine (Licence: KY 04058) | |
| 207P00000X Emergency Medicine (Licence: SC 1560) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2024-08-16 |