NPI | 1831400126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD164204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60154176) |
Enumeration Date | 2010-07-01 |
Last Update Date | 2019-08-07 |