| NPI | 1194824177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 271183-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 47297) |
| 207P00000X Emergency Medicine (Licence: TN md0000026562) | |
| 207Q00000X Family Medicine (Licence: SC 16556) | |
| 207Q00000X Family Medicine (Licence: OK 17879) | |
| 207Q00000X Family Medicine (Licence: NC 9300288) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-05-17 |