NPI | 1649684465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC DO034689) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116027094) |
Enumeration Date | 2014-06-19 |
Last Update Date | 2018-03-17 |