| NPI | 1154326635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 6637A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 6637a) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2015-05-11 |