NPI | 1841654142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301501715) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 297480) |
Enumeration Date | 2016-04-12 |
Last Update Date | 2020-08-04 |