| NPI | 1639790983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E14589) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 46990) |
| 207P00000X Emergency Medicine (Licence: GA 100907) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2025-09-10 |