| NPI | 1790709111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9401112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2011040029) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-12-11 |