NPI | 1629182647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX J1404) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX J1404) |
Enumeration Date | 2006-08-18 |
Last Update Date | 2019-09-09 |