| NPI | 1780945162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NE 30015) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0116024857) |
| Enumeration Date | 2012-06-02 |
| Last Update Date | 2017-05-24 |