| NPI | 1154388056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 117451) |
| 207P00000X Emergency Medicine (Licence: AR E2296) | |
| 207R00000X Internal Medicine (Licence: AR E-2296) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-07-16 |