| NPI | 1265495576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD0000020690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 20690) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TN MD00020690) | |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2017-08-06 |