NPI | 1376523712 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200401235) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18610) |
Enumeration Date | 2006-01-20 |
Last Update Date | 2024-09-10 |