NPI | 1528370624 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 50761) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02007636A) |
208D00000X General Practice (Licence: NY 257745) | |
Enumeration Date | 2010-07-06 |
Last Update Date | 2024-10-31 |