NPI | 1356735823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR Pending) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 20140) |
Enumeration Date | 2015-03-23 |
Last Update Date | 2023-08-02 |