NPI | 1043439870 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 15049) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 15049) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2024-11-08 |