NPI | 1407846926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 102) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2013-0459) |
207Q00000X Family Medicine (Licence: WI 36684) | |
Enumeration Date | 2005-10-26 |
Last Update Date | 2024-07-26 |