| NPI | 1154300135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 15856) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2008023872) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2008-11-19 |