| NPI | 1780983569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 46956) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01073793A) |
| 207P00000X Emergency Medicine (Licence: OK 37429) | |
| 207Q00000X Family Medicine (Licence: WI 1038) | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2024-11-22 |