NPI | 1811189269 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0442440) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25886) |
207Q00000X Family Medicine (Licence: AR E6737) | |
207Q00000X Family Medicine (Licence: CA A132344) | |
Enumeration Date | 2007-08-09 |
Last Update Date | 2020-01-23 |