NPI | 1700013661 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 8939A) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 8939A) |
207Q00000X Family Medicine (Licence: IN 11014834) | |
Enumeration Date | 2009-06-18 |
Last Update Date | 2023-07-29 |