| NPI | 1568430130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 1796) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.007269) |
| 207Q00000X Family Medicine (Licence: WV 1796) | |
| 207Q00000X Family Medicine (Licence: OH 34.007269) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-07-15 |