NPI | 1639123409 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78050) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.063506) |
207P00000X Emergency Medicine (Licence: FL ME94632) | |
Enumeration Date | 2006-05-19 |
Last Update Date | 2024-11-25 |