| NPI | 1902893167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 83652) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 83880) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2025-11-24 |