NPI | 1871622969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 59283) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 20403) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2020-02-25 |