NPI | 1407207806 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM RS2016-0468) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34534) |
Enumeration Date | 2016-06-27 |
Last Update Date | 2020-04-21 |