| NPI | 1326012683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD10381) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN MD010381) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2017-09-13 |