NPI | 1023320868 |
---|---|
Former Name | MACK SHERATON |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T1555) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 26541) |
207P00000X Emergency Medicine (Licence: GA 91796) | |
207Q00000X Family Medicine (Licence: MI 430109350) | |
207Q00000X Family Medicine (Licence: OH 35.122759) | |
Enumeration Date | 2010-07-09 |
Last Update Date | 2025-07-02 |