| NPI | 1609336528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C1-0026843) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0100566) |
| 207Q00000X Family Medicine (Licence: MD D0100566) | |
| 207Q00000X Family Medicine (Licence: DE C1-0026843) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-03-21 |