| NPI | 1417697848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U6286) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX U6286) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-07-18 |