| NPI | 1730179607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 72262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD09038) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2013-04-01 |