| NPI | 1568442689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 1427) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2007029189) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-09-27 |