NPI | 1194081851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 84511) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME121902) |
Enumeration Date | 2012-04-06 |
Last Update Date | 2020-05-15 |