NPI | 1336881978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 77440) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 47584) |
Enumeration Date | 2022-04-13 |
Last Update Date | 2025-08-10 |