| NPI | 1871774042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 46487) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 46487) |
| 207P00000X Emergency Medicine (Licence: KY 43792) | |
| 207R00000X Internal Medicine (Licence: KY 43792) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2015-03-19 |