| NPI | 1275591042 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 40522) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD40522) | 
| Enumeration Date | 2006-05-02 | 
| Last Update Date | 2025-04-22 |