| NPI | 1336149632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D43690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0043690) |
| 207R00000X Internal Medicine (Licence: MD D43690) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-11-11 |