| NPI | 1053388587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 152869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 152869) |
| 207R00000X Internal Medicine (Licence: MA 152869) | |
| 208000000X Pediatrics (Licence: MA 152869) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2007-07-08 |