NPI | 1174789531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019009748) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 173300-1205) |
Enumeration Date | 2008-08-05 |
Last Update Date | 2024-02-06 |