| NPI | 1740754217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS026203) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102206236) |
| 208D00000X General Practice (Licence: VA 0102206236) | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2026-09-14 |