| NPI | 1679663785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000042284) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35080506B) |
| 208000000X Pediatrics (Licence: TN MD42284) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-08-29 |