| NPI | 1124339882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101253190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 300636) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2018-10-10 |