| NPI | 1255442539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 017885) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 017885) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-02-07 |