| NPI | 1902801327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301047414) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MI 4301047414) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2019-01-02 |