NPI | 1235506387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15349) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102206352) |
Enumeration Date | 2015-08-25 |
Last Update Date | 2023-12-07 |