NPI | 1992967251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202845) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA Pending) |
Enumeration Date | 2008-06-27 |
Last Update Date | 2022-08-12 |