NPI | 1881048965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174389) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 57936) |
Enumeration Date | 2016-04-14 |
Last Update Date | 2021-11-14 |