| NPI | 1679563860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 47427) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 47427) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2007-11-19 |