| NPI | 1124568498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2020009906) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS ET-00119) |
| 207P00000X Emergency Medicine (Licence: AZ 10169) | |
| 208D00000X General Practice (Licence: KS ET-00119) | |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2023-07-28 |