| NPI | 1689695140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101029474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 0101029474) |
| 207P00000X Emergency Medicine (Licence: KY 0101029474) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101029474) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2017-02-24 |