NPI | 1154942068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 23975) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13396876-1205) |
Enumeration Date | 2020-05-01 |
Last Update Date | 2023-07-18 |