| NPI | 1205969953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00277) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C7-0003443) |
| 207R00000X Internal Medicine (Licence: DE C7-0003443) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2011-07-11 |