| NPI | 1770548349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD026039) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX M7290) |
| 207P00000X Emergency Medicine (Licence: LA MD026039) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2019-07-03 |