| NPI | 1982938502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 85793) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R70228) |
| 208D00000X General Practice (Licence: AZ R70228) | |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2025-11-04 |