NPI | 1871567818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 22319) |
Additional Taxonomies | 208D00000X General Practice (Licence: SC 22319) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2021-07-20 |