| NPI | 1760613319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 02337) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000046845) |
| 207P00000X Emergency Medicine (Licence: NC 2012-02337) | |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2024-01-07 |