| NPI | 1821141763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 20596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20596) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-07-16 |