| NPI | 1114902541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 35295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 35295) |
| 207R00000X Internal Medicine (Licence: TN 35295) | |
| 208M00000X Hospitalist (Licence: TN 35295) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2011-04-13 |