| NPI | 1760522650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 598842) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A72958) |
| 207P00000X Emergency Medicine (Licence: AZ 25965) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-03-22 |