NPI | 1275186165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 332738) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019023776) |
Enumeration Date | 2019-07-19 |
Last Update Date | 2022-08-03 |