| NPI | 1194807800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2015-0791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2015-0791) |
| 207P00000X Emergency Medicine (Licence: CT 041145) | |
| 207P00000X Emergency Medicine (Licence: CA C155374) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-04-29 |