| NPI | 1750358131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 25858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 25858) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TN 25858) | |
| 207V00000X Obstetrics & Gynecology (Licence: TN 25858) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN 25858) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2025-10-05 |