NPI | 1285949560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 25906) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11228) |
207Q00000X Family Medicine (Licence: AZ 2324) | |
Enumeration Date | 2010-08-11 |
Last Update Date | 2014-09-12 |