| NPI | 1124068127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 07362R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 07362R) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2018-04-11 |