| NPI | 1639433949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 0000003090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-062207) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2025-05-27 |