| NPI | 1972780781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 41695) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NY 246000) |
| 208D00000X General Practice (Licence: NY 246000) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2022-07-20 |