| NPI | 1134133556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 18749) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000044854) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: SC 38707) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-12-09 |