NPI | 1629384581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207957) |
Additional Taxonomies | 208600000X Surgery (Licence: MD P25907) |
207P00000X Emergency Medicine (Licence: LA MD.207957) | |
Enumeration Date | 2010-08-29 |
Last Update Date | 2019-11-26 |