| NPI | 1548607591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2017-01880) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2017-01880) |
| 207R00000X Internal Medicine (Licence: NC 201-018800) | |
| 207R00000X Internal Medicine (Licence: FL TRN19027) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2023-05-01 |