| NPI | 1790760262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 30029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-30029) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2026-02-27 |