| NPI | 1245970177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX u6689) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX u6689) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-04-10 |