NPI | 1447473020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101245203) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0071989) |
207Q00000X Family Medicine (Licence: DC MD039235) | |
Enumeration Date | 2007-04-11 |
Last Update Date | 2021-05-31 |