| NPI | 1225589419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 103834) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN227447) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2026-06-03 |