| NPI | 1063836765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD35658) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.35658) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-02-15 |
| Last Update Date | 2020-10-22 |