NPI | 1710247044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A137466) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10043713) |
Enumeration Date | 2012-05-21 |
Last Update Date | 2021-12-08 |