NPI | 1699903559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61057968) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202929) |
Enumeration Date | 2009-06-30 |
Last Update Date | 2021-04-05 |