| NPI | 1053404871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64847-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 84855) |
| 207P00000X Emergency Medicine (Licence: AL MD.31095) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TN 38726) | |
| 207P00000X Emergency Medicine (Licence: TN 38726) | |
| 207P00000X Emergency Medicine (Licence: VA 0101057916) | |
| 207Q00000X Family Medicine (Licence: TN 38726) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2019-09-11 |