| NPI | 1376924472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205185) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 3468) |
| 207P00000X Emergency Medicine (Licence: VA 0102205185) | |
| 207Q00000X Family Medicine (Licence: TN 3468) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116028225) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2021-06-29 |