NPI | 1205824786 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72010-20) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 70283) |
Enumeration Date | 2005-10-10 |
Last Update Date | 2024-07-03 |