NPI | 1750732418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60946168) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116029714) |
Enumeration Date | 2016-06-23 |
Last Update Date | 2019-09-17 |