| NPI | 1417924812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME48428) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME48428) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2018-10-10 |