| NPI | 1184040271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102204261) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD H0104467) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2026-05-14 |