| NPI | 1912928714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D70854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36784) |
| 207P00000X Emergency Medicine (Licence: IL 036-121255) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-01-08 |