NPI | 1114030095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a96477) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU M-2279) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2023-07-05 |