NPI | 1366738494 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 40594) |
Additional Taxonomies | 208D00000X General Practice (Licence: IA 40594) |
Enumeration Date | 2011-06-27 |
Last Update Date | 2023-08-15 |