NPI | 1962499657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0054127) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD d0054127) |
Enumeration Date | 2005-09-29 |
Last Update Date | 2024-04-29 |