NPI | 1205835469 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56163) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 051637) |
207Q00000X Family Medicine (Licence: MI 4301051637) | |
207Q00000X Family Medicine (Licence: KS 432455) | |
Enumeration Date | 2005-07-20 |
Last Update Date | 2019-06-11 |