| NPI | 1861445108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 16793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 328332) |
| 207P00000X Emergency Medicine (Licence: MS 16793) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-09-14 |