| NPI | 1306080809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 27144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 01296) |
| 207Q00000X Family Medicine (Licence: CA A134734) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2022-04-15 |