| NPI | 1235145459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 1651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 1651) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TN DO1651) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2021-08-03 |