NPI | 1801833645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-303) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 6998A) |
207Q00000X Family Medicine (Licence: WA OP60518627) | |
Enumeration Date | 2006-06-01 |
Last Update Date | 2023-01-27 |