| NPI | 1164580775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 17340) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 46966) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: NC 17340) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2018-07-26 |