| NPI | 1598737991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 1947) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.008017) |
| 208D00000X General Practice (Licence: KY 03066) | |
| 208D00000X General Practice (Licence: SC 51270) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-10-20 |