| NPI | 1629016126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 14798) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 14798) |
| 207P00000X Emergency Medicine (Licence: TN 1619) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-04-25 |