| NPI | 1134344195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 59062) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2025-06-06 |