| NPI | 1346457116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 18734) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 18734) |
| 122300000X Dentist (Licence: HI M8095) | |
| 171000000X Military Health Care Provider (Licence: AL 18734) | |
| 171100000X Acupuncturist (Licence: AL 18734) | |
| 207P00000X Emergency Medicine (Licence: HI M8095) | |
| 207Q00000X Family Medicine (Licence: AL 18734) | |
| 207Q00000X Family Medicine (Licence: HI M8095) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: HI M8095) | |
| 209800000X Legal Medicine (Licence: AL 18734) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-05-28 |