| NPI | 1679567523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY C3932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.098156) |
| 207P00000X Emergency Medicine (Licence: TN 37837) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2025-12-23 |