NPI | 1467536524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38012) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 98-01668) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2021-10-11 |