| NPI | 1457351165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN 2851) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A8256) |
| 207P00000X Emergency Medicine (Licence: TX M5512) | |
| 207P00000X Emergency Medicine (Licence: KY 03597) | |
| 207P00000X Emergency Medicine (Licence: TN 2851) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2015-08-07 |