NPI | 1750645214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28062) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV LL2269) |
Enumeration Date | 2012-06-29 |
Last Update Date | 2022-08-10 |