| NPI | 1821068420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3039) |
| 207P00000X Emergency Medicine (Licence: WV 3039) | |
| 207P00000X Emergency Medicine (Licence: KY 04652) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-02-28 |