NPI | 1093724882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 52148) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO01675) |
Enumeration Date | 2006-08-08 |
Last Update Date | 2021-04-09 |