NPI | 1619401874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD27969) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD048248) |
207Q00000X Family Medicine (Licence: OH 35142950) | |
Enumeration Date | 2017-04-14 |
Last Update Date | 2024-06-25 |