| NPI | 1194216176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6664) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2025043413) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2026-04-07 |