| NPI | 1225291487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 39118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8669) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2026-01-12 |