| NPI | 1639116882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C130369) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35072579D) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2025-04-23 |