NPI | 1689235764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME162457) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 253852) |
207P00000X Emergency Medicine (Licence: PA MT218934) | |
Enumeration Date | 2019-06-27 |
Last Update Date | 2023-10-19 |