| NPI | 1659314748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101260969) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 32865) |
| 207Q00000X Family Medicine (Licence: NC 32865) | |
| 207Q00000X Family Medicine (Licence: TN 54731) | |
| 207Q00000X Family Medicine (Licence: VA 0101260969) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-07-07 |