NPI | 1457556557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 64500) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 29759) |
Enumeration Date | 2007-06-19 |
Last Update Date | 2024-01-30 |