NPI | 1366426074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 30642) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 5203) |
Enumeration Date | 2005-12-06 |
Last Update Date | 2024-08-15 |