NPI | 1104972207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 12794) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R1216) |
207P00000X Emergency Medicine (Licence: OH 35.122205) | |
Enumeration Date | 2007-01-25 |
Last Update Date | 2023-08-08 |