NPI | 1548571987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 88785) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 165698) |
Enumeration Date | 2010-06-30 |
Last Update Date | 2021-04-28 |