| NPI | 1790124733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 55257) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000055257) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-02-19 |