| NPI | 1114298916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 2405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 22204) |
| 207P00000X Emergency Medicine (Licence: TN 2405) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2015-10-02 |