| NPI | 1356704779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A168036) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042.0014419) |
| 207P00000X Emergency Medicine (Licence: VT 042.0014419) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2020-10-12 |