| NPI | 1447827977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 37355) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 37355) |
| 207P00000X Emergency Medicine (Licence: NE 37355) | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2026-08-31 |