NPI | 1982798310 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 97817) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0052091) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2024-02-13 |