| NPI | 1962686030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D71459) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC den5938) |
| 122300000X Dentist (Licence: MD 15670) | |
| 207P00000X Emergency Medicine (Licence: DC MD036903) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2019-10-25 |