NPI | 1265645220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3429) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 562) |
Enumeration Date | 2007-05-07 |
Last Update Date | 2018-08-19 |