| NPI | 1952523169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD21742) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: OR MD21742) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2023-03-07 |