| NPI | 1952835126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2020-00765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 111160) |
| 208D00000X General Practice (Licence: VA 0101266049) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2026-06-29 |