NPI | 1417934563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 1638) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD9415) |
207Q00000X Family Medicine (Licence: NE 17260) | |
Enumeration Date | 2005-12-29 |
Last Update Date | 2021-07-28 |