NPI | 1316253180 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D76654) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101256283) |
Enumeration Date | 2010-08-31 |
Last Update Date | 2020-07-29 |