| NPI | 1033506274 |
|---|---|
| Other Name | CORKY LICK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 70308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 61361) |
| 207P00000X Emergency Medicine (Licence: GA 82768) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2021-10-10 |