| NPI | 1063414522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 056220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 36761) |
| 207R00000X Internal Medicine (Licence: NM MD2016-0649) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2018-11-19 |