| NPI | 1467411256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101044759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101044759) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-09-11 |