NPI | 1477576478 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97816) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 17521) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2023-08-01 |