| NPI | 1740798099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-49440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301114884) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 749940) | |
| 207Q00000X Family Medicine (Licence: IA MD-49440) | |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2026-02-11 |