| NPI | 1538163506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 37770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000037770) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2018-10-09 |