| NPI | 1992999437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 117768) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 17951) |
| 208D00000X General Practice (Licence: PR 17951) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2019-01-25 |