| NPI | 1972603231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9500043) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 95-00043) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-03-07 |