| NPI | 1982602157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-01986) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 19090) |
| 207P00000X Emergency Medicine (Licence: NC 2012-01986) | |
| 207R00000X Internal Medicine (Licence: WV 19090) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-06-03 |