| NPI | 1992449722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 8125) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: OK 8125) |
| 207P00000X Emergency Medicine (Licence: OK 8125) | |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-06-09 |