| NPI | 1124406152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 78178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37632) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2026-07-09 |