NPI | 1235581539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 57799) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: ND RL14102) |
Enumeration Date | 2016-07-11 |
Last Update Date | 2024-04-12 |