| NPI | 1508206889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203949) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203949) |
| 207R00000X Internal Medicine (Licence: IL 125062734) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2024-11-13 |