| NPI | 1922053248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140368) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 46482) |
| 207P00000X Emergency Medicine (Licence: VA 0101223755) | |
| 207P00000X Emergency Medicine (Licence: NC 2004-01105) | |
| 207R00000X Internal Medicine (Licence: NC 2004-01105) | |
| 207R00000X Internal Medicine (Licence: VA 0101223755) | |
| 207R00000X Internal Medicine (Licence: KY 46482) | |
| 208D00000X General Practice (Licence: NC 2004-01105) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2021-09-22 |