| NPI | 1790364198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-01934) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS20676) |
| 207Q00000X Family Medicine (Licence: FL OS20676) | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-07-09 |