NPI | 1780734541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101242082) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101242082) |
Enumeration Date | 2007-01-11 |
Last Update Date | 2020-02-24 |