NPI | 1811935935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 013387) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 013307) |
Enumeration Date | 2006-06-02 |
Last Update Date | 2013-12-20 |