| NPI | 1760945513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102207300) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102207300) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-11-19 |