| NPI | 1245492958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 66075) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 49365) |
| 207P00000X Emergency Medicine (Licence: SC 83261) | |
| 207Q00000X Family Medicine (Licence: GA 066075) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2025-04-21 |