NPI | 1790048239 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020034539) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE Anthony 6740) |
208D00000X General Practice (Licence: KS 0438079) | |
Enumeration Date | 2012-06-20 |
Last Update Date | 2020-10-16 |