| NPI | 1568086668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 75470) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2024025977) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-12-09 |