| NPI | 1891716460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J9940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101049491) |
| 207R00000X Internal Medicine (Licence: TX J9940) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2009-01-06 |