| NPI | 1699816975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101236151) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101236151) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-01-25 |