| NPI | 1992774202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101226382) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200000715) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2021-03-05 |