| NPI | 1801835947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 55281) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 55281) |
| 207P00000X Emergency Medicine (Licence: FL ME92005) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-09-30 |