| NPI | 1245961127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA DO-06650) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-06650) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2026-04-23 |