NPI | 1821115585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 59822) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 000547) |
Enumeration Date | 2007-03-26 |
Last Update Date | 2024-01-03 |