| NPI | 1760985949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102205869) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2021-01651) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2022-11-04 |