| NPI | 1154476737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 41509) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IN 01063106A) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-07-19 |