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 |