| NPI | 1073614251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301054536) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 43054536) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301054536) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2017-05-03 |