Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 18955 | SC |
NPI | 1083715940 |
---|---|
Provider Name | Ahmad Boota |
First Address | Greenville, SC 29601-3971 |
Second Address | Greenville, SC 29601-3971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 07/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E63456 | (02) | SC |