| NPI | 1316567480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-51658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX bp10070441) |
| Enumeration Date | 2020-04-19 |
| Last Update Date | 2026-03-16 |