NPI | 1215613658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL90327) |
Additional Taxonomies | 208D00000X General Practice (Licence: SC 90327) |
Enumeration Date | 2023-06-22 |
Last Update Date | 2025-05-27 |