| NPI | 1366686180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101051572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD23495) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2019-02-28 |