| NPI | 1972636652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 026113) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 026113) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2018-09-04 |