| NPI | 1780893982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301083438) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301083438) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2009-01-14 |