NPI | 1689723793 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201879) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD 235439) |
Enumeration Date | 2007-01-09 |
Last Update Date | 2024-05-07 |