| NPI | 1033111919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-02295) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 24096) |
| 207R00000X Internal Medicine (Licence: NC 2016-02295) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2017-01-17 |