NPI | 1285210625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 86146) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL86146) |
Enumeration Date | 2021-03-23 |
Last Update Date | 2025-03-11 |