NPI | 1003255845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021030564) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 256384) |
Enumeration Date | 2013-06-14 |
Last Update Date | 2022-09-15 |