| NPI | 1023042504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 61206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200400684) |
| 207P00000X Emergency Medicine (Licence: SC 87576) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 200400684) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-04-26 |