NPI | 1790848299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 45923) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MP 0348) |
207Q00000X Family Medicine (Licence: CA A067909) | |
Enumeration Date | 2006-12-18 |
Last Update Date | 2021-03-22 |