| NPI | 1053361402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 45851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 600) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-03-10 |