| NPI | 1508894197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS013145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102202342) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-11-08 |