NPI | 1285802876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 7306) |
Additional Taxonomies | 172V00000X Community Health Worker (Licence: AL 7306) |
Enumeration Date | 2008-02-15 |
Last Update Date | 2016-02-19 |