NPI | 1952410904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 23905) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 3557561205) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2021-09-27 |