| NPI | 1861432593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204367) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: IN 02003033A) |
| 207P00000X Emergency Medicine (Licence: WV 1453) | |
| 207Q00000X Family Medicine (Licence: OH 34.007997) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 1453) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-02-02 |