| NPI | 1407927502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.124512) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2008-0008) |
| 207P00000X Emergency Medicine (Licence: IA 37615) | |
| 207P00000X Emergency Medicine (Licence: IN 01054855A) | |
| 207P00000X Emergency Medicine (Licence: NY 219294) | |
| 207P00000X Emergency Medicine (Licence: NY 219294-1) | |
| 207R00000X Internal Medicine (Licence: NY 219294) | |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2020-01-08 |