| NPI | 1720067606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101008321) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102202236) |
| 207P00000X Emergency Medicine (Licence: PA OS014356) | |
| 207R00000X Internal Medicine (Licence: MI 5101008321) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2016-09-22 |