NPI | 1356533863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: MO 2016010160) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21305) |
Enumeration Date | 2007-08-17 |
Last Update Date | 2025-07-15 |