| NPI | 1801886593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 37720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 64562) |
| 207R00000X Internal Medicine (Licence: IL 036-094540) | |
| 207R00000X Internal Medicine (Licence: WI 37720) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2023-08-22 |