| NPI | 1821040783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 4005) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-003773) |
| 207P00000X Emergency Medicine (Licence: WI 69191) | |
| 207R00000X Internal Medicine (Licence: NM 4005) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-01-03 |