NPI | 1174985808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83498-20) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10395937-1205) |
Enumeration Date | 2016-03-22 |
Last Update Date | 2024-06-14 |