NPI | 1023639374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME168592) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208D00000X General Practice (Licence: KY 58464) | |
Enumeration Date | 2020-04-28 |
Last Update Date | 2024-06-27 |