NPI | 1316028947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 124117) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11341) |
207Q00000X Family Medicine (Licence: CO 45117) | |
207Q00000X Family Medicine (Licence: WI 48498-020) | |
Enumeration Date | 2006-10-18 |
Last Update Date | 2020-10-03 |