| NPI | 1598007049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD230651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 48220) |
| 207Q00000X Family Medicine (Licence: WI 3536) | |
| 207Q00000X Family Medicine (Licence: KY 48220) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 48220) | |
| 207Q00000X Family Medicine (Licence: NC 2024-01726) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2026-07-07 |