NPI | 1538458864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34977) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 272513) |
Enumeration Date | 2011-04-07 |
Last Update Date | 2022-07-18 |