NPI | 1801096821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01366) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL1085) |
208D00000X General Practice (Licence: NC 2012-01366) | |
Enumeration Date | 2007-07-18 |
Last Update Date | 2023-10-14 |