| NPI | 1104871854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 1454) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-099617) |
| 207R00000X Internal Medicine (Licence: KY 03257) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2022-07-06 |