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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3201 SPRINGHILL DR STE 300, NORTH LITTLE ROCK, AR 72117-2909
(501) 753-4132
Mailing address
20925 LAHSER RD APT 113, SOUTHFIELD, MI 48033-4418
(908) 627-5257

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E-15537
AR

Other

Enumeration date
03/31/2020
Last updated
07/24/2023
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