| NPI | 1740381276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 33599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 33599) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 33599) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-01-18 |