NPI | 1811166366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247115) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190089) |
Enumeration Date | 2008-02-28 |
Last Update Date | 2012-08-08 |