| NPI | 1871288860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-00341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-00341) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2026-03-10 |