| NPI | 1760481014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 23453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 23453) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-04-21 |