NPI | 1104081082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 75198) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31545) |
Enumeration Date | 2008-07-21 |
Last Update Date | 2021-10-19 |