| NPI | 1790273092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 59932) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 12208313-1205) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: UT 12208313-1205) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-08-04 |