NPI | 1972611051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0037617) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: DC MD19758) |
Enumeration Date | 2006-08-28 |
Last Update Date | 2023-03-07 |