NPI | 1740368984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA g83999) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME151720) |
207Q00000X Family Medicine (Licence: TX T4994) | |
207Q00000X Family Medicine (Licence: HI MD20796) | |
207Q00000X Family Medicine (Licence: NY 310574) | |
Enumeration Date | 2006-11-02 |
Last Update Date | 2024-06-19 |