| NPI | 1023034972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 30744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101045525) |
| 207P00000X Emergency Medicine (Licence: LA MD.09541R) | |
| 207Q00000X Family Medicine (Licence: VA 0101045525) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-05-15 |