| NPI | 1366856403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS15745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016121) |
| 207P00000X Emergency Medicine (Licence: CA 20A16159) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2019-10-24 |