NPI | 1568447688 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240477) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 43474) |
207P00000X Emergency Medicine (Licence: VA 0101240477) | |
207P00000X Emergency Medicine (Licence: NC 2014-02031) | |
Enumeration Date | 2005-12-13 |
Last Update Date | 2024-08-07 |