| NPI | 1972594828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101054534) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101054534) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2008-05-15 |