| NPI | 1497591366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2025048999) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2025048999) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-11-25 |