NPI | 1366893281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 76411) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R75735) |
207Q00000X Family Medicine (Licence: AZ 57761) | |
Enumeration Date | 2016-06-22 |
Last Update Date | 2024-01-19 |