| NPI | 1063450237 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 1733) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN DO1733) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-06-14 |