NPI | 1174545917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 7324) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60170584) |
Enumeration Date | 2006-07-24 |
Last Update Date | 2022-01-06 |