NPI | 1669787305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 67139) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004193A) |
207Q00000X Family Medicine (Licence: VA 0102203115) | |
Enumeration Date | 2010-08-17 |
Last Update Date | 2020-11-16 |