NPI | 1821480666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006453) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014033463) |
207Q00000X Family Medicine (Licence: NY 275096) | |
Enumeration Date | 2015-03-03 |
Last Update Date | 2018-03-17 |