| NPI | 1992738397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102049857) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 1361) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2025-09-23 |