| NPI | 1417993767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO16713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 62526) |
| 207R00000X Internal Medicine (Licence: WI 68842) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2026-02-10 |