| NPI | 1881337137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 9000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-18155) |
| 207Q00000X Family Medicine (Licence: AR E-18155) | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-09-25 |