NPI | 1760613319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 02337) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000046845) |
207P00000X Emergency Medicine (Licence: NC 2012-02337) | |
Enumeration Date | 2009-07-30 |
Last Update Date | 2024-01-07 |