| NPI | 1285713156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 21688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21688) |
| 207Q00000X Family Medicine (Licence: KY TP578) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WV 21688) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-03-07 |