| NPI | 1902899917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 40493-020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 40493-020) |
| 208600000X Surgery (Licence: WI 40493-020) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2025-09-11 |