| NPI | 1407824477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD10003) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD10003) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-10-03 |