| NPI | 1891185229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101260860) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2392) |
| 208D00000X General Practice (Licence: VA 0116028716) | |
| 208D00000X General Practice (Licence: VA 0101260860) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2023-11-30 |