| NPI | 1346731635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.43245) |
| 207P00000X Emergency Medicine (Licence: GA 92679) | |
| 207Q00000X Family Medicine (Licence: OK 33902) | |
| 207P00000X Emergency Medicine (Licence: OK 33902) | |
| 207P00000X Emergency Medicine (Licence: AL MD.43245) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2026-01-21 |