NPI | 1003102245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6209) |
Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P6209) |
207P00000X Emergency Medicine (Licence: TX P6209) | |
Enumeration Date | 2011-06-27 |
Last Update Date | 2015-06-30 |