| NPI | 1962750323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 72978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 076754) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2025-04-25 |