| NPI | 1699765297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 55249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 55249) |
| 207R00000X Internal Medicine (Licence: NH 21230) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2023-11-27 |