NPI | 1912240698 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17489) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102270) |
Enumeration Date | 2013-04-01 |
Last Update Date | 2017-11-18 |