| NPI | 1902093594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2006014590) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2006014590) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2014-10-31 |