| NPI | 1598175341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205057) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102205057) |
| 207R00000X Internal Medicine (Licence: VA 0102205057) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102205057) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208600000X Surgery (Licence: VA 0102205057) | |
| 208000000X Pediatrics (Licence: VA 0102205057) | |
| 207Q00000X Family Medicine (Licence: VA 0102205057) | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2026-04-24 |