| NPI | 1912965575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN MD0000048615) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 22767) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-02-18 |