| NPI | 1164401618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD11915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 11915) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2009-08-03 |