| NPI | 1972798163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0066825) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101241281) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2013-06-13 |