NPI | 1548686447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-03367) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18800) |
Enumeration Date | 2014-03-16 |
Last Update Date | 2022-08-25 |