NPI | 1184280984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2022-0650) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD216748) |
Enumeration Date | 2019-05-16 |
Last Update Date | 2023-09-19 |