NPI | 1528284262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25274) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 37965) |
207P00000X Emergency Medicine (Licence: NE 25274) | |
Enumeration Date | 2007-04-18 |
Last Update Date | 2019-11-21 |