| NPI | 1811688070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301517379) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351051235) |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2026-06-22 |