NPI | 1093700296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: AZ 3813) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3813) |
Enumeration Date | 2005-09-13 |
Last Update Date | 2022-07-21 |