| NPI | 1982644407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 31023) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 052451) |
| 207P00000X Emergency Medicine (Licence: SC 27336) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-08-18 |