NPI | 1770895070 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013026514) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8840) |
Enumeration Date | 2010-07-02 |
Last Update Date | 2020-11-11 |