| NPI | 1972587418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 08597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 013830) |
| 207P00000X Emergency Medicine (Licence: MS 08597) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2014-09-04 |