NPI | 1255451811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A60939) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 197637) |
207Q00000X Family Medicine (Licence: MD D55869) | |
Enumeration Date | 2007-03-29 |
Last Update Date | 2024-09-19 |