NPI | 1265162168 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD224652) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351049991) |
Enumeration Date | 2022-06-14 |
Last Update Date | 2025-07-03 |