NPI | 1053548354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60190278) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004375A) |
Enumeration Date | 2009-06-15 |
Last Update Date | 2023-05-02 |