| NPI | 1770655896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9600960) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 9600960) |
| 207P00000X Emergency Medicine (Licence: NC 9600960) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2017-01-05 |