| NPI | 1902291297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 37220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101265786) |
| 207Q00000X Family Medicine (Licence: VA 0101265786) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-04-02 |