| NPI | 1841292760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 26955) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35074338) |
| 207P00000X Emergency Medicine (Licence: FL ME117705) | |
| 207P00000X Emergency Medicine (Licence: IN 01068774A) | |
| 208D00000X General Practice (Licence: WV 26955) | |
| 208D00000X General Practice (Licence: OH 35074338) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2023-11-27 |