NPI | 1578589115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C167687) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1038) |
207Q00000X Family Medicine (Licence: NV 12502) | |
Enumeration Date | 2006-07-15 |
Last Update Date | 2023-03-07 |