| NPI | 1699189720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205676) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016145) |
| 207Q00000X Family Medicine (Licence: VA 0102205676) | |
| 207Q00000X Family Medicine (Licence: PA OT016145) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-08-11 |