| NPI | 1114920253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101034362) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME53345) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-05-31 |