| NPI | 1508854407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-02494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-02494) |
| 207R00000X Internal Medicine (Licence: SC 40084) | |
| 207P00000X Emergency Medicine (Licence: NC 2014-02494) | |
| 207P00000X Emergency Medicine (Licence: SC 40084) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2024-11-20 |