| NPI | 1972554699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 032498) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 40364) |
| 207Q00000X Family Medicine (Licence: GA 032498) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-06-25 |