| NPI | 1912392507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 17606) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 17606) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-09-08 |