NPI | 1730246745 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 26649) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 23452) |
Enumeration Date | 2007-01-02 |
Last Update Date | 2023-09-15 |