| NPI | 1679654917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 19994) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.19994) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-12-06 |