| NPI | 1841257532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 234079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME78683) |
| 207P00000X Emergency Medicine (Licence: MA 234079) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2012-07-07 |