| NPI | 1457540445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 50632) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA FM4197213) |
| 207Q00000X Family Medicine (Licence: OK 25939) | |
| 207Q00000X Family Medicine (Licence: SC MD33196) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2025-03-14 |