NPI | 1700033925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD18316) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 364110-1205) |
Enumeration Date | 2008-08-19 |
Last Update Date | 2024-08-15 |