| NPI | 1508094103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 31708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL31708) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-11-06 |