| NPI | 1235475260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TN DO0000003002) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-02546) |
| 207Q00000X Family Medicine (Licence: VA VA0116025430) | |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2019-07-26 |