NPI | 1720398225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203038) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0116023238) |
Enumeration Date | 2010-10-18 |
Last Update Date | 2023-05-03 |