NPI | 1881128353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61065129) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10939795-1204) |
Enumeration Date | 2017-04-11 |
Last Update Date | 2021-06-02 |