| NPI | 1669472072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0047891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0047891) |
| 207P00000X Emergency Medicine (Licence: VA 0101058203) | |
| 207R00000X Internal Medicine (Licence: DC MD046246) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-01-22 |