NPI | 1063964666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS15034) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 299267) |
207Q00000X Family Medicine (Licence: FL OS15034) | |
Enumeration Date | 2016-10-30 |
Last Update Date | 2022-03-09 |