| NPI | 1811348535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205759) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102205759) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2019-10-31 |