| NPI | 1629042775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 74786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 74876) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-08 |