NPI | 1730537218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-13929) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1575) |
Enumeration Date | 2016-05-25 |
Last Update Date | 2020-11-24 |