| NPI | 1376235028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021022123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 2021022123) |
| 207R00000X Internal Medicine (Licence: MO 2021022123) | |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-09-20 |