NPI | 1003591926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MI 4031512896) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4031512896) |
207R00000X Internal Medicine (Licence: MI 4351050811) | |
Enumeration Date | 2023-06-19 |
Last Update Date | 2024-09-12 |