| NPI | 1225038649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 21833) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D58109) |
| 207P00000X Emergency Medicine (Licence: VA 0101245805) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2025-06-24 |