NPI | 1619047495 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os11563) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006688E) |
Enumeration Date | 2006-11-08 |
Last Update Date | 2021-04-30 |