| NPI | 1649774993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 28055) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL DO2868) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2026-02-10 |