NPI | 1902866080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 18732) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 18732) |
Enumeration Date | 2006-03-24 |
Last Update Date | 2022-02-16 |