| NPI | 1780983569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 68311) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 30133) |
| 208D00000X General Practice (Licence: SC 84940) | |
| 208D00000X General Practice (Licence: NV 20451) | |
| 208D00000X General Practice (Licence: PA MD472198) | |
| 208D00000X General Practice (Licence: MS 28281) | |
| 208D00000X General Practice (Licence: WY 13120c) | |
| 207Q00000X Family Medicine (Licence: WI 1038) | |
| 208D00000X General Practice (Licence: CO dr.0065155) | |
| 207P00000X Emergency Medicine (Licence: FL ME146686) | |
| 208D00000X General Practice (Licence: KY 46956) | |
| 208D00000X General Practice (Licence: SD 12317) | |
| 208D00000X General Practice (Licence: NJ 25MA10949500) | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2026-02-27 |