NPI | 1063569341 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60556066) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301095325) |
207Q00000X Family Medicine (Licence: IA 37955) | |
Enumeration Date | 2007-01-05 |
Last Update Date | 2021-04-08 |