NPI | 1184292096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011735) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12244) |
Enumeration Date | 2021-06-16 |
Last Update Date | 2025-07-26 |