| NPI | 1538736061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 343486) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 343486) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2026-08-17 |