NPI | 1174571855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9700565) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 12243) |
Enumeration Date | 2006-05-04 |
Last Update Date | 2024-11-04 |