NPI | 1154856367 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 51156) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 51156) |
Enumeration Date | 2017-04-25 |
Last Update Date | 2021-06-03 |