NPI | 1013394576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19518) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO2397) |
Enumeration Date | 2015-05-04 |
Last Update Date | 2023-03-09 |