NPI | 1154618130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12489) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11964) |
Enumeration Date | 2011-06-29 |
Last Update Date | 2023-06-14 |