| NPI | 1548962467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 76621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 111513) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-07-08 |