| NPI | 1992743322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0000000847) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 847) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2022-07-21 |