NPI | 1417053117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014006968) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD24824) |
207Q00000X Family Medicine (Licence: HI MD7151) | |
Enumeration Date | 2006-09-16 |
Last Update Date | 2019-05-07 |