| NPI | 1699110379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2019018127) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 1.084417) |
| 208D00000X General Practice (Licence: MO 2019018127) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2026-04-21 |