NPI | 1457672289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 32853) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL32853) |
Enumeration Date | 2010-06-16 |
Last Update Date | 2020-12-08 |