NPI | 1215497235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 329365) |
Additional Taxonomies | 208D00000X General Practice (Licence: LA 329365) |
Enumeration Date | 2019-03-25 |
Last Update Date | 2023-12-20 |