| NPI | 1053336826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 43525) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 17778) |
| 207R00000X Internal Medicine (Licence: KY 43525) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-10-01 |