| NPI | 1720029275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 36478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 36478) |
| 207Q00000X Family Medicine (Licence: LA MD.13301R) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-05-22 |