| NPI | 1790730331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 28862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 28862) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-11-03 |