| NPI | 1669987335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 69750) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 2730) |
| 207Q00000X Family Medicine (Licence: KY C2090) | |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2025-05-08 |