| NPI | 1811254360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 262269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 262269) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2015-06-01 |