NPI | 1235704610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027270) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151014984) |
Enumeration Date | 2021-05-26 |
Last Update Date | 2024-07-08 |