NPI | 1376275719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME174635) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125081015) |
207Q00000X Family Medicine (Licence: IL 036172592) | |
Enumeration Date | 2022-06-24 |
Last Update Date | 2025-08-08 |