| NPI | 1609807882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD034388) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2023024383) |
| 207Q00000X Family Medicine (Licence: MO 2023024383) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-08-22 |