| NPI | 1710514500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301513487) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301513487) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-09-08 |