NPI | 1588190276 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0443442) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL.0006523) |
Enumeration Date | 2017-05-02 |
Last Update Date | 2020-08-26 |