| NPI | 1760985535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101267416) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101267416) |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2025-10-09 |