| NPI | 1396438990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301515305) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4351051209) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2026-01-06 |