| NPI | 1508895509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 41002) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0036103) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2017-01-12 |