NPI | 1003295072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00652) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 38055) |
Enumeration Date | 2015-05-23 |
Last Update Date | 2020-10-26 |