NPI | 1821436726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301110787) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 191644) |
Enumeration Date | 2013-06-13 |
Last Update Date | 2016-09-02 |