| NPI | 1013981042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35063580) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 054178) |
| 207Q00000X Family Medicine (Licence: GA 054178) | |
| 207P00000X Emergency Medicine (Licence: FL ME 89642) | |
| 207Q00000X Family Medicine (Licence: FL ME 89642) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2014-09-17 |