NPI | 1407197684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2020012799) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AR C-8117) |
Enumeration Date | 2013-03-12 |
Last Update Date | 2020-09-30 |