NPI | 1659484509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10963) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0007593) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2020-11-25 |