| NPI | 1952317893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101249122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101249122) |
| 207Q00000X Family Medicine (Licence: GA 058031) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-05-18 |