| NPI | 1124017280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0029220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 22386) |
| 207P00000X Emergency Medicine (Licence: TX M7971) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2019-05-18 |