NPI | 1457481343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 6741) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44228) |
Enumeration Date | 2007-03-07 |
Last Update Date | 2018-10-29 |