NPI | 1528094075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0071260) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME105086) |
207Q00000X Family Medicine (Licence: IL 036-090644) | |
Enumeration Date | 2006-06-25 |
Last Update Date | 2023-10-03 |