NPI | 1497015903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05117) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 1129) |
207P00000X Emergency Medicine (Licence: KS 05-38247) | |
Enumeration Date | 2012-05-18 |
Last Update Date | 2019-07-18 |