| NPI | 1689619835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 75111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 75111) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2008-07-01 |