| NPI | 1912902982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME88887) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD27970) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2023-01-18 |