NPI | 1578945010 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL38337) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 38337) |
Enumeration Date | 2015-06-21 |
Last Update Date | 2018-09-27 |