NPI | 1023038684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 10815R) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18480) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2022-07-21 |