NPI | 1568724219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-01671) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-1547) |
Enumeration Date | 2012-06-08 |
Last Update Date | 2024-11-21 |