| NPI | 1831765585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011061) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 011061) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2025-10-03 |