NPI | 1902865470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17317) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3071) |
Enumeration Date | 2006-03-22 |
Last Update Date | 2022-08-10 |