| NPI | 1144250671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN APN06890) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN06890) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-11-18 |