| NPI | 1912975046 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 38768) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 38768) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-11-16 |