NPI | 1205091576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154230) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL10887) |
Enumeration Date | 2008-07-25 |
Last Update Date | 2020-10-14 |