NPI | 1376708438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44455) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 30782) |
207Q00000X Family Medicine (Licence: SC 30782) | |
Enumeration Date | 2008-07-28 |
Last Update Date | 2022-09-26 |