| NPI | 1295706976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56256) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35063874) |
| 207P00000X Emergency Medicine (Licence: KY 56256) | |
| 207R00000X Internal Medicine (Licence: OH 35063874) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-01-14 |