| NPI | 1821213067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD0000030054) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD48929) |
| 207V00000X Obstetrics & Gynecology (Licence: TN MD0000030054) | |
| 208D00000X General Practice (Licence: FL ME140190) | |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2025-09-19 |