| NPI | 1841731114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 28719) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 28719) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-04-08 |