| NPI | 1679100481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206975) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 5158) |
| 208D00000X General Practice (Licence: VA 0102206975) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-08-09 |