NPI | 1215062831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 55189) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.13795R) |
Enumeration Date | 2007-02-22 |
Last Update Date | 2021-09-13 |