| NPI | 1053373399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200300020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200300020) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2025-12-23 |