| NPI | 1124063177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 51101) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 29636) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN 29636) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2023-04-17 |