| NPI | 1780775692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 21740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 21740) |
| 207Q00000X Family Medicine (Licence: KY 30944) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-05-22 |