| NPI | 1659791861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 25021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 007004) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2026-02-13 |