NPI | 1003006149 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-01775) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A93276) |
207Q00000X Family Medicine (Licence: MA 232725) | |
Enumeration Date | 2007-07-25 |
Last Update Date | 2021-12-15 |