NPI | 1861694424 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 87500) |
Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P5079) |
207Q00000X Family Medicine (Licence: SC 32276) | |
207Q00000X Family Medicine (Licence: TX P5079) | |
Enumeration Date | 2007-06-04 |
Last Update Date | 2024-04-24 |