NPI | 1487061271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14766) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015753) |
Enumeration Date | 2014-07-14 |
Last Update Date | 2022-07-21 |