| NPI | 1184374589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-00200) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 83823) |
| 207R00000X Internal Medicine (Licence: NC 2021-00200) | |
| 207R00000X Internal Medicine (Licence: GA 83823) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-03-28 |