| NPI | 1891376778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511273) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301511273) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-08-01 |