NPI | 1598898363 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0734) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 356087-1205) |
207Q00000X Family Medicine (Licence: MA 79259) | |
Enumeration Date | 2007-03-13 |
Last Update Date | 2019-10-03 |