| NPI | 1548559693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60587278) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60587278) |
| 207P00000X Emergency Medicine (Licence: OK 34988) | |
| 207Q00000X Family Medicine (Licence: OK 34988) | |
| 207Q00000X Family Medicine (Licence: TN 49970) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2022-01-03 |