| NPI | 1851518989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2025002707) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-32704) |
| 207Q00000X Family Medicine (Licence: MO 2025002707) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2025-10-14 |