NPI | 1184286296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 40329) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15846) |
Enumeration Date | 2019-06-28 |
Last Update Date | 2025-01-21 |