| NPI | 1235124207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD31309) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN MD31309) |
| 207P00000X Emergency Medicine (Licence: KY 49518) | |
| 207R00000X Internal Medicine (Licence: TN 31309) | |
| 207R00000X Internal Medicine (Licence: KY 49518) | |
| 208000000X Pediatrics (Licence: TN MD31309) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2023-05-02 |