| NPI | 1760599575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 67046) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 45618) |
| 207P00000X Emergency Medicine (Licence: TN 45045) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TN 45045) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.127417) | |
| 207R00000X Internal Medicine (Licence: KY 45618) | |
| 208M00000X Hospitalist (Licence: KY 45618) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-01-18 |