NPI | 1629308051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AP3503) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3503) |
Enumeration Date | 2010-01-07 |
Last Update Date | 2016-08-25 |