| NPI | 1124004239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 18393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 18393) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2022-02-28 |