NPI | 1356960298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME167047) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351047281) |
Enumeration Date | 2020-04-10 |
Last Update Date | 2025-07-17 |