| NPI | 1053390641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-02301) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME55187) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2018-06-04 |