| NPI | 1417990334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 028490) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 028490) |
| 207Q00000X Family Medicine (Licence: GA 028490) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-07-22 |