| NPI | 1518306935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116026055) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 03990) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2020-11-02 |