NPI | 1508855024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D58755) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0058755) |
Enumeration Date | 2005-10-18 |
Last Update Date | 2016-12-09 |