| NPI | 1598771222 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 11816) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 11816) | 
| Enumeration Date | 2006-08-01 | 
| Last Update Date | 2019-01-31 |