NPI | 1104856640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-12484) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA C53578) |
207P00000X Emergency Medicine (Licence: OR MD181900) | |
207Q00000X Family Medicine (Licence: NM NM-2001-146) | |
Enumeration Date | 2006-07-03 |
Last Update Date | 2017-09-11 |