| NPI | 1780099358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.129582) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 57006) |
| 207R00000X Internal Medicine (Licence: KY 50241) | |
| 207P00000X Emergency Medicine (Licence: KY 50241) | |
| 207P00000X Emergency Medicine (Licence: AL 53716) | |
| 207P00000X Emergency Medicine (Licence: NC 2017-02085) | |
| 207P00000X Emergency Medicine (Licence: AR E-10704) | |
| 207P00000X Emergency Medicine (Licence: WI 67570-20) | |
| 207P00000X Emergency Medicine (Licence: IL 036.143140) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2026-05-29 |