| NPI | 1932176724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 54827) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01076431A) |
| 207P00000X Emergency Medicine (Licence: KY 54827) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2025-04-24 |