| NPI | 1730133604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9501307) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9501307) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: LA 11695R) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-06-29 |