NPI | 1336860774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 1499) |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: PR 022867) |
Enumeration Date | 2022-09-05 |
Last Update Date | 2023-08-02 |