| 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 |