| NPI | 1508866633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WV 15554) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WV 15554) |
| 207P00000X Emergency Medicine (Licence: WV 15554) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-03-18 |