| NPI | 1366651507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 80265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 080265) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-08-31 |