NPI | 1255563987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37586) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012024847) |
207Q00000X Family Medicine (Licence: IA R-8701) | |
Enumeration Date | 2009-08-13 |
Last Update Date | 2023-02-16 |