| NPI | 1942892880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2024012318) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 81289-20) |
| 208D00000X General Practice (Licence: WI 81289-20) | |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2026-04-30 |