NPI | 1104870591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.011700) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 011700) |
Enumeration Date | 2006-05-20 |
Last Update Date | 2018-11-30 |