| NPI | 1013080167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52495) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 253328) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2014-09-10 |