| NPI | 1063807022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-16351) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 12009729-1205) |
| 207P00000X Emergency Medicine (Licence: NV 17765) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: ID M-16351) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-10-17 |