NPI | 1356720049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA op61443176) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205469) |
Enumeration Date | 2015-05-27 |
Last Update Date | 2024-08-14 |