NPI | 1316948425 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60096330) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055440A) |
Enumeration Date | 2005-08-10 |
Last Update Date | 2021-05-10 |