| NPI | 1699160986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 78526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-00548) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-07-31 |