NPI | 1689793093 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60812507) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 161776) |
208D00000X General Practice (Licence: WA 60812507) | |
Enumeration Date | 2007-03-28 |
Last Update Date | 2022-12-21 |