NPI | 1346655669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX R4626) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R4626) |
Enumeration Date | 2014-06-25 |
Last Update Date | 2025-02-13 |