NPI | 1306871496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 35955) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 10575) |
Enumeration Date | 2006-07-11 |
Last Update Date | 2022-12-22 |