| NPI | 1407146095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 279821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000050705) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TN MD0000050705) | |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2016-02-02 |