| NPI | 1710305479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101272695) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 79674) |
| 207R00000X Internal Medicine (Licence: GA 079674) | |
| 207R00000X Internal Medicine (Licence: VA 0101272695) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-03-05 |