| NPI | 1619406758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A173077) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301119035) |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2021-08-06 |