NPI | 1063891570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-11402) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9865992-1205) |
Enumeration Date | 2015-05-29 |
Last Update Date | 2018-07-19 |