NPI | 1376984021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C183981) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 306663) |
207Q00000X Family Medicine (Licence: OR MD177129) | |
207Q00000X Family Medicine (Licence: MI 4301103809) | |
Enumeration Date | 2013-07-10 |
Last Update Date | 2023-11-08 |