NPI | 1861703217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12106) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013452) |
Enumeration Date | 2010-06-30 |
Last Update Date | 2023-08-03 |