NPI | 1770609596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 51874) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 12324) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2023-03-07 |