NPI | 1952310831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.08482R) |
Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: LA 08482R) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2020-07-02 |