| NPI | 1609034412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 2454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2026) |
| 207Q00000X Family Medicine (Licence: WV 2454) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-07-20 |