| NPI | 1043912678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R82717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 199099) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-07-01 |