| NPI | 1740459338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301088085) |
| Additional Taxonomies | 208D00000X General Practice (Licence: UT 4756787-1205) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2026-01-05 |