NPI | 1417945304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 21998) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 21998) |
Enumeration Date | 2005-10-13 |
Last Update Date | 2014-12-10 |