NPI | 1316175797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 72824) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D74188) |
Enumeration Date | 2009-06-24 |
Last Update Date | 2023-07-31 |