NPI | 1104096619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 11039) |
Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 11039) |
Enumeration Date | 2008-03-11 |
Last Update Date | 2022-07-21 |