| NPI | 1578510079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD021356) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 21356) |
| 207R00000X Internal Medicine (Licence: TN 21356) | |
| 207P00000X Emergency Medicine (Licence: VA 0101048181) | |
| 207R00000X Internal Medicine (Licence: TN MD021356) | |
| 207R00000X Internal Medicine (Licence: VA 0101048181) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2011-03-14 |