| NPI | 1164785325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301100909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100909) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-01-16 |