NPI | 1033107255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 214747) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 40581) |
Enumeration Date | 2005-10-11 |
Last Update Date | 2025-08-25 |