NPI | 1093802894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2006-0489) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106375) |
207Q00000X Family Medicine (Licence: AZ 44320) | |
Enumeration Date | 2006-10-05 |
Last Update Date | 2021-08-13 |