| NPI | 1366477549 |
|---|---|
| Other Name | JERRY LYNN FENWICK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 110179) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 18407) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-01-20 |