| NPI | 1770550634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC 15130) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0035826) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-12-16 |