NPI | 1093155988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6210629-1204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1325) |
Enumeration Date | 2013-06-25 |
Last Update Date | 2021-08-02 |