NPI | 1548559693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60587278) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60587278) |
207P00000X Emergency Medicine (Licence: OK 34988) | |
207Q00000X Family Medicine (Licence: OK 34988) | |
207Q00000X Family Medicine (Licence: TN 49970) | |
Enumeration Date | 2011-03-29 |
Last Update Date | 2022-01-03 |