NPI | 1245980150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13502724-1205) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61674581) |
Enumeration Date | 2022-03-24 |
Last Update Date | 2025-07-15 |