NPI | 1356070940 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 35546) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V7857) |
Enumeration Date | 2022-06-08 |
Last Update Date | 2025-05-20 |