NPI | 1104812270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 22198) |
Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NE 22198) |
Enumeration Date | 2005-09-23 |
Last Update Date | 2024-07-30 |