| NPI | 1104872019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101045615) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-02252) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-10-15 |