| NPI | 1083318505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 73759) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 73759) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2026-06-25 |