| NPI | 1962462614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME77808) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME77808) |
| 207R00000X Internal Medicine (Licence: FL ME77808) | |
| Enumeration Date | 2006-03-26 |
| Last Update Date | 2016-03-19 |