| NPI | 1609986926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 11529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 25469) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-04-14 |