| NPI | 1104974237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA os013373) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS 0213373) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-09-15 |