| NPI | 1972691541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 41705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125050533) |
| 207Q00000X Family Medicine (Licence: KY 41705) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-10-10 |