NPI | 1548614563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a17139) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15085) |
207Q00000X Family Medicine (Licence: AZ 007993) | |
207Q00000X Family Medicine (Licence: NV DO2524) | |
207R00000X Internal Medicine (Licence: CA 20A17139) | |
Enumeration Date | 2016-04-15 |
Last Update Date | 2022-09-01 |